Chronic adhesive spinal arachnoiditis: Pathogenesis, prognosis, and treatment

Arachnoiditis was first described as a complication of chronic meningitis and now occurs in patients who have undergone multiple myelograms and multiple lumbar surgeries. All myelographic agents currently available produce an inflammatory response. The water-soluble agents now in use produce less response than do any agents of the past. Arachnoiditis is associated with technically imperfect myelography and complicated, extensive, and multiple lumbar surgeries. The diagnosis is best made by repeat myelography. There is no specific clinical syndrome. There is no definitive treatment. Intrathecal steroids and microlysis of adhesions have been employed therapeutically in a limited way. Correction of instability and neural compression syndromes is effective even with known arachnoiditis. The problem remains a therapeutic challenge.